Healthcare Provider Details

I. General information

NPI: 1801409727
Provider Name (Legal Business Name): NATIONAL SUPPLY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 N DIXIE HWY
BOCA RATON FL
33431-5028
US

IV. Provider business mailing address

4401 N DIXIE HWY
BOCA RATON FL
33431-5028
US

V. Phone/Fax

Practice location:
  • Phone: 347-441-8559
  • Fax:
Mailing address:
  • Phone: 800-496-3534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HENDERSON
Title or Position: MEMBER MANAGER
Credential:
Phone: 347-441-8559